By Peters D; Davies P; Pietroni P
Address: Marylebone Health Centre, London.
BACKGROUND. A musculoskeletal clinic, staffed by a general practitioner
trained in osteopathy, medical acupuncture and intralesional
injections, was set up in an inner London general practice in 1987.
AIM. A retrospective study was undertaken of one year's referrals to
the clinic in 1989-90 to determine how general practitioners were using
the clinic in terms of problems referred; consultation patterns of
patients attending the clinic and 12 months after initially being seen;
and how access to the clinic influenced referrals to relevant hospital
METHOD. Day sheets were studied which recorded information
on demographic characteristics of patients referred to the clinic and
their problems, diagnoses made, duration of symptoms, number and range
of treatments given, and recurrence of problems. Use of secondary
referral sources was also examined.
RESULTS. During the study year 154
of 3264 practice patients were referred to the musculoskeletal clinic,
and attended a mean of 3.5 times each. Of all the attendees 64% were
women and 52% were 30-54 years old. Eighty one patients (53%) presented
with neck, back or sciatic pain. A specific traumatic, inflammatory or
other pathological process could be ascribed to only 19% of patients.
Regarding treatment, 88% of patients received osteopathic manual
treatment or acupuncture, or a combination of these treatments and 4%
received intralesional injections. Nine patients from the clinic (6%)
were referred to an orthopaedic specialist during the year, two with
acute back pain. Referrals to orthopaedic specialists by the practice
as a whole were not significantly lower than the national average,
although the practice made fewer referrals to physiotherapy and
rheumatology departments than national figures would have predicted.
Seventeen patients (11%) returned to the clinic with a recurrence of
their main complaint within a year of their initial appointment; second
courses of treatment were usually brief.
CONCLUSION. The clinic
encouraged a relatively low referral rate to musculoskeletal
specialists outside the practice. However, a need was identified for
better communication about the potential of the approaches used in
order that referrals to secondary specialists, particularly orthopaedic
specialists, could be further reduced.